Category Archives: Technology
EHRs Linked to Lower Rates of Hospitalization
The use of electronic health records (EHRs) is linked to lower rates of hospitalization, according to a new study in the Journal of the American Medical Association. Researchers tracked approximately 170,000 people treated for diabetes between 2005 and 2008, finding that changing from paper records to EHRs was associated with a decrease in hospitalizations of between 5 and 6 percent. There was no link to a change in the number of overall doctors’ office visits. The U.S. government has committed about $30 billion for the widespread implementation of EHRs. Rainu Kaushal, MD, director of the Center for Healthcare Informatics and Policy at Weill Cornell Medical College in New York, who was not involved in the study, said while the study shows that investment in EHRs is important, it is also just one piece of what needs to be done to improve overall care. "An EHR is a critical infrastructural tool to change the way in which healthcare is delivered, but it is one of a set of tools that needs to be employed," she said. "It's when you start getting those pieces together…that you really start finding some significant changes in utilization." Read more on technology.
FDA Proposes Stronger Safety Labels of Opioids
In response to the growing public health problem of opioid-related overdose and death, the U.S. Food and Drug Administration (FDA) is calling for stronger safety labeling for long-acting and extended-release opioids. New labeling will emphasize both the dangers of abuse and possible death—there were 16,651 in 2010, according to FDA—and the risk for women who are pregnant. "The FDA is invoking its authority to require safety labeling changes and postmarket studies to combat the misuse, abuse, addiction, overdose and death from these potent drugs that have harmed too many patients and devastated too many families and communities," said FDA Commissioner Margaret Hamburg in a release. “Today’s action demonstrates the FDA’s resolve to reduce the serious risks of long-acting and extended release opioids while still seeking to preserve appropriate access for those patients who rely on these medications to manage their pain.” Read more on prescription drugs.
IOM: Nation Faces Looming ‘Cancer Crisis’
An aging population, rising health care costs, the complexity of care and other issues are leading the United States toward a future cancer crisis, according to a new report from the Institute of Medicine (IOM). Current estimates predict as many as 2.3 million new cancer diagnoses per year by 2030, with the total cost of cancer care expected to climb to $173 billion by 2020. The report concluded that what’s needed is a shift toward patient-centered, evidence-focused care. "Most clinicians caring for cancer patients are trying to provide optimal care, but they're finding it increasingly difficult because of a range of barriers," said Patricia Ganz, chairwoman of the committee that wrote the report and a professor at the School of Medicine and School of Public Health at the University of California, Los Angeles. "As a nation, we need to chart a new course for cancer care. Changes are needed across the board, from how we communicate with patients to how we translate research into practice to how we coordinate care and measure its quality." Read more on cancer.
New York City is currently developing a pilot public health program known as NYC Macroscope — the first domestic effort to aggregate electronic health record (EHR) data into a surveillance tool to inform public health decisions. The population health surveillance system will compile electronic health records from primary care practices to help city health officials monitor—and respond to—the real-time prevalence of conditions that impact public health. The project is the result of a partnership between the New York City Health Department and the CUNY School of Public Health, with support from the Robert Wood Johnson Foundation’s Pioneer Portfolio, and additional support from the de Beaumont Foundation, Robin Hood and the New York State Health Foundation.
NewPublicHealth spoke with Carolyn Greene, MD, Deputy Commissioner of the NYC Department of Health and Mental Hygiene’s Division of Epidemiology, about the plans and goals for the program.
NewPublicHealth: Tell us about NYC Macroscope and how it will work.
Carolyn Greene: NYC Macroscope is going to be New York City’s first electronic health record surveillance system. We have a program here at the health department called Primary Care Information Project (PCIP), and it’s one of the nation’s largest distributed electronic health record networks. PCIP began in 2005. It concentrated on primary care practices in high need areas where the Health Department really wanted to encourage providers to use electronic health records. The program has been extremely successful and they’ve completed many different activities to improve the quality of clinical care.
But in recent years, we’ve been asking the question: Can we use electronic health records for more than just patient care? Can we, in fact, use electronic health records to monitor the health of the population? Here at the Health Department, we have many different ways to conduct population health surveillance. We have surveys that we conduct by telephone, we have disease registries that we host, and we have our vital statistics registry on deaths and births. All these data are very important. But they are costly, resource-intensive and they often have a time lag from when the data are collected to when we can actually find the results from the data, so the advantages of an electronic health record surveillance system are many.
One advantage is that the architecture is already there. If you already have the electronic health records in place, you don’t have to find additional resources to collect the data because you’re already collecting the data through the EHR architecture. Other advantages are that potentially you can collect data in real time and potentially at low cost.
NPH: Do you see any potential disadvantages?
Greene: I think the first one is we always have to ask how representative the data will be in terms of representing the population as a whole. First of all, electronic health records only collect data on people who are in care and, because sicker patients go to the doctor more frequently, there’s a greater likelihood that we may be picking up more information on sicker patients. So we have questions about how representative are the data.
Conflicts of Interest in Determination of Food Additive Safety
Who determines whether a food additive is safe? Often it’s people with ties to the food additive industry, according to a new conflict-of-interest study from The Pew Charitable Trusts in the journal JAMA Internal Medicine. From 1997 to 2012, about 20 percent of safety determinations submitted to the U.S. Food and Drug Administration were authored by employees of food additive manufacturers, and 13 percent were authored by someone working a consultant selected by the manufacturer. Researchers also found that the expert panels tasked with conducting most of the safety assessments rely on many of the same experts over and over again. "There's a cadre of 10 people that serve on almost all of these expert panels," said study author Thomas Neltner, director of Pew's food additives project. "Three-quarters of the panels contained at least one of these people. One person served on 44 percent of the panels, which tells us there's not only conflicts of interest, but there's a very small group of people making these decisions." Michael Jacobson, executive director of the Center for Science in the Public Interest, sees these results as a clear problem that needs to be addressed. "These committees give a very superficial, one-sided review," he said. "They want to please the sponsor, and then maybe they will get more business because they've proven themselves trustworthy, but it's no way to run a food safety review process." Read more on food safety.
CDC: 1 in 8 Preschoolers Obese, Raising their Risk for Adult Obesity
About one in eight—or 12 percent—of preschoolers are obese. However, after decades spent watching that number climb, nineteen states and territories are seeing drops in obesity among low-income preschoolers, according to the latest Vital Signs report from the U.S. Centers for Disease Control and Prevention (CDC). Overweight and obese children are five times more likely to grow up to be obese adults, so early intervention by state and local health officials is critical. The report provides a number of ways they can help, including the creation of partnerships with community members to make community changes that promote healthy eating and active living, as well as making it easier for families with children to buy healthy, affordable foods and beverages in their neighborhoods. Read more on obesity.
Hospitals’ Exchange of Electronic Health Records Climbed 41 Percent from 2008 to 2012
Health information exchange (HIE) between hospitals and providers outside their organizations climbed 41 percent from 2008 to 2012, with six in 10 hospitals exchanging electronic health records (EHR) in 2012, according to a new study in the journal Health Affairs. The researchers say this illustrates how EHRs have become complementary tools that improve health care quality and safety. “We know that the exchange of health information is integral to the ongoing efforts to transform the nation’s health care system and we will continue to see that grow as more hospitals and other providers adopt and use health IT to improve patient health and care,” said Farzad Mostashari, MD, the National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services. “Our new research is crystal clear: health information exchange is happening and it is growing. But we still have a long road ahead toward universal interoperability.” Read more on technology.
MERS Unlikely to Cause Pandemic; Global Cooperation Still Needed
Middle East respiratory syndrome (MERS), which emerged last year in Saudi Arabia, was compared to severe acute respiratory syndrome (SARS) and found to be less infectious, in a new study published in The Lancet Infectious Diseases. The study examined the question of whether MERS has the potential to cause a pandemic, and how quickly. The study authors concluded that MERS does not yet have pandemic potential, and in fact appears to be less infectious than SARS. There have been 81 laboratory-confirmed cases of MERS infections, 45 of which were fatal. MERS is more likely to affect older men with chronic disease, and were most often transmitted in health care settings—but unlike SARS, the virus was less likely to also infect healthy health care workers. Researchers call for healthcare facilities to prepare to provide safe care for patients with acute respiratory infections, and take measures to help prevent the spread of the disease. Read more on infectious disease.
CDC: HPV Vaccination Rates for Adolescent Girls Remain Stagnant
Just over half (53.8%) of girls age 13-17 years old received the human papilloma virus (HPV) vaccine in 2012, with no increase over the rate in 2011. Since 2006, the Advisory Committee on Immunization Practices has recommended routine vaccination of adolescent girls at ages 11 or 12 years with 3 doses of HPV vaccine. HPV causes 70 percent of cervical cancers. If HPV vaccine had been offered during healthcare visits when girls were already in the office to get a different vaccine, HPV vaccination coverage could have reached 90 percent. Approximately 79 million persons in the United States are infected with HPV, and approximately 14 million will become newly infected each year. Each year, 26,000 new cases of cancer are diagnosed that can be traced back to HPV infection. Read more on vaccines.
New Breathalyzer-like Device Tells You If Your Workout is Working
New technology being prototyped in Japan measures how well you're burning body fat and help you gauge the success of your diet and exercise program, using a smartphone and pocket-sized, bluetooth enabled device. The device measures exhaled breath for acetone, a metabolite produced from fat burning. The researchers tested the device in 17 healthy men and women, reporting their findings online July 25 in the Journal of Breath Research, and finding that the device was as effective as more established "gold standard" measures. Further research is needed on larger, more diverse populations, but if it pans out, "Enabling users to monitor the state of fat burning could play a pivotal role in daily diet management," Hiyama said in a journal news release. Read more on technology.
Up to 80 percent of family physicians are expected to use electronic health records (EHRs) by the end of this year, and experts across the country are talking about ways to leverage this influx of data to inform better health. A pre-conference workshop at the National Association of County and City Health Officials (NACCHO) Annual Meeting focused on Beacon Communities, which are part of a pilot to demonstrate how meaningful use of EHRs can lead to better health and better health care at a lower cost. The HHS Office of the National Coordinator for Health IT is providing $250 million over three years to 17 selected communities throughout the United States where numerous institutions are sharing data to inform quality improvement and other data-informed efforts.
The NACCHO meeting highlighted Beacon communities that are partnering with public health in different ways to forge data-informed population health activities.
Health departments in North Carolina have been required to do community assessments since 2002 as part of a statewide health department accreditation program and are very experienced with working with this data, whereas hospitals are just now beginning to be required to do similar assessments under the affordable care act, according to John Graham, PhD, PMP, Senior Investigator for the NC Institute for Public Health at the Gillings School for Global Public Health, which plays an integral role in the Southern Piedmont Beacon Community.
“Health assessment planning and communication are tools that can be leveraged to foster more collaboration,” said Graham. “We really try to coordinate public health prevention and health care. We can do a lot with clinical interventions, looking at it from a population health perspective.”
Much Like Television, Excessive Cell Phone Use Lowers Fitness Levels
Are you reading this on your smartphone? If so, it’s probably not doing your weight any good. A new study in the International Journal of Behavioral Nutrition and Physical Activity has linked cell phone use by college students to decreased physical activity and fitness levels. Much like watching television, cell phone use is a largely sedentary activity that is easy to get lost in. It can also lead to casual overeating. Researchers found the average student spent about five hours on the phone each day and sent hundreds of text messages. "We have to look at this similar to what happened in the industrial revolution and how it changed us," said Nancy Copperman, director of public health initiatives at North Shore-LIJ Health System, in Great Neck, N.Y. "A study like this raises the importance of how this technology affects how we move, eat and sleep. We have to look at the impact of technology on our health." Read more on technology.
Study Links Bipolar Disorder, Early Death
A new study showing that people with bipolar disorder are more likely to die early and from a variety of causes also illustrates the difficulty of treating the physical effects of the illness. "Whatever we're doing, these people are not dying (just) because of suicide. That's not the reason for increased mortality. That's a hard thing to get across," said David Kupfer, PhD, a professor of psychiatry at the University of Pittsburgh School of Medicine, who was not a part of the study. The study found that people with bipolar disorder—an estimated 1 to 5 percent of the global population—die about nine years earlier and are at higher risk for heart disease, diabetes, chronic obstructive pulmonary disorder, the flu and pneumonia. However, people who knew they were bipolar had the same death rates as those who were not, which suggests "that timely medical diagnosis and treatment may effectively reduce mortality among bipolar disorder patients to approach that of the general population," according to the study. Read more on mental health.
One Dose of ADHD Medication Improves Balance in Older Adults
A single dose of an attention deficit/hyperactivity disorder (ADHD) medication can improve the balance of older adults who have difficulty walking, according to a new study in The Journals of Gerontology. Methylphenidate (MPH) is also used to treat narcolepsy. Researchers at Ben-Gurion University of the Negev found that it can reduce the number and rate of step errors in both single and dual tasks. "Our results add to a growing body of evidence showing that MPH may have a role as a therapeutic option for improving gait and reducing fall risk in older adults," said Itshak Melzer of BGU's Schwartz Movement Analysis and Rehabilitation Laboratory, Department of Physical Therapy, Faculty of Health Sciences. "This is especially true in real-life situations, where the requirement to walk commonly occurs under more complicated, 'dual task' circumstances with cognitive attention focused elsewhere (e.g., watching traffic, talking) and not on performing a specific motor task." Read more on aging.
Study: The Longer People Are Obese, the Greater Their Risk for Heart Disease
At a time when obesity rates for both U.S. adults and children are rising, new research indicates that the longer someone is obese, the greater their risk for heart disease. The study appeared in the Journal of the American Medical Association. "Each year of obesity was associated with about a 2 to 4 percent higher risk of subclinical coronary heart disease," said study lead author Jared Reis, an epidemiologist with the U.S. National Heart, Lung, and Blood Institute. "Those with longest duration of both overall obesity and abdominal obesity tended to have the highest risk [for subclinical disease].” Subclinical heart disease includes arterial damage indicated by markers such as calcium buildup on arterial walls, but which “has not yet developed into symptomatic illness,” according to HealthDay. The study is yet more evidence of the need to focus on the prevention and treatment of childhood obesity, according to the researchers. Read more on heart health.
EHRs Would Help Doctors’ Offices Cut Costs Slightly
Doctors’ offices that utilize electronic health records (EHRs) will spend less per patient than offices that use traditional paper records, according to a new study in the journal Annals of Internal Medicine. While the savings is expected to be small—about $5 per patient per month—they will add up over time. With a government commitment of about $30 billion for the widespread adoption of EHRs, the hope is the decrease in inefficiencies, incorrect care and errors will lead to better, cheaper health care. Previous studies have shown conflicting results. Rainu Kaushal, MD, who wrote an editorial that accompanied the study, said that while she does not expected the EHRs to contribute significantly to cost savings, their adoption is still vital. "EHRs may or may not directly contribute to those savings… but without investing in them you cannot achieve new models of healthcare delivery," said Kaushal, director of the Center for Healthcare Informatics and Policy at Weill Cornell Medical College in New York. Read more on technology.
No Evidence of Benefits of Community-wide Dementia Screening
New research has found no proof that there are any clinical, economic or emotional benefits to programs that use community-wide screening to identify people with dementia. "We found no evidence that population screening would lead to better clinical or psychosocial outcomes, no evidence furthering our understanding of the risks it entails and no indication of its added value compared to current practice," said author Carol Brayne, a professor of public health medicine from Cambridge Institute of Public Health, in the United Kingdom. The debate over the strategy’s efficacy has been going on for quite some time, with one side noting that there isn’t even a cure for Alzheimer’s disease, and the other noting that as many as half of the people with dementia remain undiagnosed. The researchers, however, did emphasize that family and friends should be aware of the warning signs of dementia so they can help loved ones get treatment. Read more on community health.
NCI Releases Massive Data Set to Help Cancer Researchers
The National Cancer Institute (NCI) has released a massive data set of cancer-specific genetic variations to help the cancer research community gain a better understanding or both drug response and drug resistance to cancer treatments. The data set was published in Cancer Research, a journal of the American Association for Cancer Research. The database—the largest worldwide—includes 6 billion data points connecting “drugs with genomic variants for the whole human genome across cell lines from nine tissues of origin, including breast, ovary, prostate, colon, lung, kidney, brain, blood, and skin,” said Yves Pommier, MD, PhD, NCI’s chief of the Laboratory of Molecular Pharmacology. “Opening this extensive data set to researchers will expand our knowledge and understanding of tumorigenesis [the process by which normal cells are transformed into cancer], as more and more cancer-related gene aberrations are discovered,” he said. “This comes at a great time, because genomic medicine is becoming a reality, and I am very hopeful this valuable information will change the way we use drugs for precision medicine.” Read more on cancer.
FDA Approves Device that Uses the Brain’s Electrical Impulses to Diagnose ADHD
The U.S. Food and Drug Administration (FDA) has approved the marketing of the first medical device that will look at a brain’s electrical impulses to help determine whether children and adolescents have attention-deficit/hyperactivity disorder (ADHD). The 15-20 minute test for people ages 6 to 17, which utilizes electroencephalogram technology, can be used to confirm an ADHD diagnosis or help health professionals decide whether further testing should focus on ADHD. “Diagnosing ADHD is a multistep process based on a complete medical and psychiatric exam,” said Christy Foreman, director of the Office of Device Evaluation at the FDA’s Center for Devices and Radiological Health. “The NEBA System along with other clinical information may help health care providers more accurately determine if ADHD is the cause of a behavioral problem.” Read more on technology.
Study: Divorce When a Child is Young Negatively Impacts Later Parental Relationship Security
Young children whose parents divorce may have more difficult and less secure relationships with their parents later in life, according to a new study in the journal Personality and Social Psychology Bulletin. Researchers looked at date from 7,335 men and women with the average age of 24, finding those whose parents divorced when they were age 5 or younger had less secure parental relationships as adults. A secure relationship means that the child feels “they can trust them and depend on them and that the parent will be available psychologically,” according to HealthDay. The negative effect was especially true for relationships with the father. The study found that participants were more likely to have a “strained” relationship with the parent they did not live with after the divorce; about 74 percent of the participants lived with their mothers and only 11 percent lived with their fathers. Omri Gillath, an associate professor of social psychology at the University of Kansas, said the results demonstrate the need for divorcing parents to be as civilized as possible. Read more on pediatrics.
Employer Mandate to Provide Health Insurance for Workers Delayed One Year
The U.S. Department of the Treasury announced yesterday that implementation of the rule under the Affordable Care Act requiring employers with more than fifty workers to provide health insurance or pay penalties beginning January 1, 2014, will be delayed by one year. Read more on access to health care.
Pharmacist-guided Home Hypertension Monitoring Shows Significant Results
Home blood pressure monitoring augmented by partnering with a pharmacist can lead to greater improvements in hypertension than the traditional treatments, according to a new study in the Journal of the American Medical Association. People in the study intervention group received a home blood pressure monitor, training and lifestyle advice. The monitor automatically sent updates to the pharmacists, who could adjust treatment accordingly. About 72 percent of the study participants who underwent the new care combination had their hypertension under control after six months, compared to 45 percent for the participants who underwent the usual care. This control also persisted months after the interventions. “The reason that only about half of people with [high] blood pressure have it under control is that usual care isn't working. We combined two interventions that we thought would be very powerful together—home monitoring and pharmacist managements—and this is one system that we've shown works very well for blood pressure control," said senior investigator Karen Margolis, MD, from the HealthPartners Institute for Education and Research in Minneapolis. About 30 percent of U.S. adults suffer from high blood pressure. Read more on heart health.
HHS Issues Final Plan on Improving Patient Care Utilizing Health IT
The Department of Health and Human Services (HHS) has issued its final “Health IT Patient Safety Action and Surveillance Plan” to utilize health information technology (IT) to better protect patients and improve the quality of care. “When implemented and used properly, health IT is an important tool in finding and avoiding medical errors and protecting patients,” said National Coordinator for Health IT Farzad Mostashari, MD. “This Plan will help us make sure that these new technologies are used to make health care safer.” The Office of National Coordinator for Health IT plan outlines the responsibilities of both HHS and the private sector. It includes making it easier to report health IT-related incidents and hazards using certified electronic health record technology; encouraging reports to Patient Safety Organizations and updating standardized reporting forms; encouraging the use of standardized reporting forms in hospital incident reporting systems; and training on how to use the forms to identify safe and unsafe health IT practices. Read more on technology.